In the 21st century, a new motto has come to the fore: “When the going feels impossible, the impossible is challenged with innovation”.
As was the case when Dr. Meara and his innovative idea revolutionized the medical world with 3D-printing but more so to help fix little Violet Pietrok.
On February 12, 2013, Violet and Cora were born to Alicia and Matt Pietrok in Oregon. Although just 2 minutes apart, Violet was born with a rare cranial condition called, Tessier facial cleft. This meant that her facial tissues and skull’s structure did not come together properly. In specific, her eyes were spread apart and nasal cavity did not have much cartilage.
After a lot of research about how to make their little girl better, Alicia and Matt traveled to Boston, to discuss Violet’s condition with John Meara, the MD and vice-chair of neurosurgery, and Peter Weinstock, the MD, and director of SIMPeds, of Boston’s Children’s Hospital.
Being such a rare condition, Alicia expressed that this is something medical students see as a case study for cranial facial surgery, but the hands on application was just not there yet and was still uncharted territory. However, the doctors who worked on Violet had worked on children with similar conditions four times before, in the past few years.
Therefore, as the first step, Dr. Meara and Dr. Weinstock did some MRI scans and then printed a 3D-model of Violet’s skull, based on the data and specifications fed in by them. The 3D-printer laid layers of resin down to literally restructure her exact cranial features along with acrylic colors to pinpoint exact spots. This gave them a simulated hard copy to understand Violet’s condition without the interference of tissue and skin covering the area.
After that, they took it back to the lab and tried to make various cuts, which helped foresee any possible hindrances, or if bone structures would make contact if they were to bring her eyes together. With the help of these models, they can practice and do it a repeated number of times, to determine the perfect technique to go about it. In the past, however, Dr. Meara says, “The first time you’d be doing it would be on the patient, but 3D-printing has enabled us to see areas of the skull and be able to dismantle it in ways that have never been done before.”
This way, the 3D-models they worked with, would be a blueprint or map to guide them as they move her eyes closer together and carry-on to press the uneven parts of her skull back to their correct positions, down to the millimeter.
After their immense preparations and practices, the doctors briefed Alicia and Matt about Violet’s surgery. Alicia expressed concerns as to whether moving the facial bone together could compromise the functions of the tissue and organs in Violet’s face such as the optical nerve which enables her to see.
Nevertheless, Dr. Meara and Dr. Weinstock reassured that it would be fine.
Violet was prepped for phase one of her surgery, which was to bring her eyes closer together and close the gap in her forehead. After over 10 hours of surgery, Dr. Meara walked out smiling stating it was a success. Violet then stayed in Boston for 6 weeks to recover.
Still being her sweet and naughty self, she won the hearts of many in the neighborhood. Meanwhile, Dr. Meara frequently checks on the family through Skype and by phone to give advice to Alicia on how to care for the stitches and surgical wounds and more.
After Violet’s skull has healed and the cranial tissues have adapted to the new structure, the second phase begins with adjusting the nasal tissues, which is projected to happen in spring 2016, before little Violet goes to first grade, followed by other cosmetic surgeries until her face is repaired completely.
This case is one of the many advantages of 3D-printing to make medical procedures shorter and more accurate, changing the face of surgery for the better.